[Urinary diversion 1989].

Abstract

Recent years have seen increasing of interest in enterocystoplasty owing to a considerable expansion of its applications for bladder reconstruction. The significantly improved outcome of enterocystoplasty in the past few years is the culmination of a long history of triumphs and failures, improvements in patient care and selection, proper bowel preparation, and use of antibiotics. There are various factors that can influence the outcome, such as choice, length, shape and size of bowel segment, protection of the upper tracts and urinary continence. Of the numerous bladder substitutes the ileal neobladder seems to be clearly the best, combining a large reservoir capacity, a low pressure system, guaranteed continence both day and night and simple and effective construction. Total bladder substitution in the female remains an unsolved problem. The functional rectal bladder (augmented and valved rectum) is a first step. The success that is possible with the Kock pouch, as with all other pouches, is tempered by the need for reoperations, mainly for repair to the efferent nipple; reoperation is a major surgical challenge in all bladder substitute procedures.